The American College of Nurse-Midwives (ACNM) reaffirms its strong opposition to efforts seeking to dismantle important legal protections afforded under the Health Care Rights Law (Section 1557 of the Affordable Care Act (ACA)). Last month, a federal judge in the Northern District of Texas overturned an Obama-era regulation that prohibits discrimination by health care providers and insurers on the basis of race, color, gender identity, national origin, sex, age, termination of pregnancy or disability in health programs or activities administered by a federal agency and the ACA health insurance marketplaces ruling that the policy violates the religious freedoms of Christian providers.
“ACNM’s Philosophy of Care is founded on a belief that all people have a right to health care that is equitable, ethical, and accessible and that respects human dignity, individuality, and diversity among groups,” stated ACNM President Susan Stone, CNM, DNSc, FACNM, FAAN. “Further, we specifically affirm the rights of transgender and gender non-conforming individuals to care that is delivered in an unbiased, safe, respectful, and equitable manner. No person should be denied the ability to see a midwife or access their health insurance based on their sex, gender identity or color of their skin. This court’s decision will rollback critical protections and puts countless individuals at risk of continued harm from inadequate and discriminatory health care.”
The October 15, 2019, decision comes as the Department of Health and Human Services (HHS) works to finalize a proposed rule from earlier this spring that seeks to limit the scope of civil rights protections established under the Health Care Rights Law.
Numerous reports, including one by the National Center for Transgender Equality, have documented extensive discrimination against transgender and gender nonconforming individuals in accessing health care as well as significantly higher health disparities.2 Moreover, care that is provided is often delivered in a way that is inadequate, disrespectful, or increases distress and trauma. Transgender and gender non-conforming individuals report experiencing lower rates of health insurance coverage than the general population and one-third (33%) of those who saw a health care provider in the past year reported having at least one negative experience related to being transgender, with higher rates for people of color and people with disabilities. Additionally, as many as one-fourth of transgender people avoid health care services due to concerns about discrimination and harassment.”2
ACNM supports access to comprehensive health care for every individual. As ACNM’s related position statement notes, “Everyone has the right to make choices regarding sexual and reproductive health (SRH) that meet their individual needs…. Every individual has the right to safe, supportive, and affirming health care in which providers demonstrate respect for human dignity. ACNM supports each person’s right to self-determination, access to comprehensive health information, and active participation in all aspects of an individualized plan of care.”3
1. Trump Administration Plan to Roll Back Health Care Nondiscrimination Regulation: Frequently Asked Questions. National Center for Transgender Equality. https://transequality.org/HCRL-FAQ. Accessed October 17, 2019.
2. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. http://www.ustranssurvey.org/reports#USTS Accessed October 17, 2019
3. Access to Comprehensive Sexual and Reproductive Health Care Services. American College of Nurse-Midwives. Approved 1991. Reviewed and Revised, October 2016. http://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000087/Access-to-Comprehensive-Sexual-and-Reproductive-Health-Care-Services-FINAL-04-12-17.pdf. Accessed October 17, 2019.